Emergency Transfusion Guide University of Chicago Medicine

Transcription

1 Emergency Transfusion Guide University of Chicago Medicine Step 1: Administer emergency O Negative RBCs if stored on your unit. Step 2: Select the appropriate emergency transfusion pathway. A. Emergency release: - Patient needs 1-5 units of RBCs, 1-3 units of FFP, or 1 plateletpheresis emergently - Blood will be uncrossmatched unless the patient already has units crossed. B. Adult or Obstetrical Massive Transfusion Protocol (MTP): - Patient needs 6 units RBCs in 4 hours, or - Replacement of total body volume (TBV) in 24 hours, or - Blood loss >150 ml/min - The first MTP pack will be uncrossmatched regardless of Type & Screen status C. Pediatric MTP indications: - Patient age 0-17 years old - Replacement of >50% TBV in 3 hours, or - Replacement of >100% TBV in 24 hours, or - Blood loss >10% TBV/min - The first MTP pack will be uncrossmatched regardless of Type & Screen status Step 3: Follow the attached guide(s) - ALWAYS call Blood Bank first to request emergency release or activate MTP - Place Epic transfusion orders when time allows Contact: Ariana King Revised January 2018

2 Blood Bank turn-around-times: Emergency Transfusion Guide University of Chicago Medicine Task or Test Turn-around-time Stat Type & Screen 60 min from receipt Stat ABO Verification 15 min from receipt Product thawing (frozen plasma, cryoprecipitate) min Extended crossmatch (for antibodies) 60+ min Product preparation, Emergency release < 5 min 1 st MTP pack (for patients age >15) 10 min Product prep, 2 nd or greater MTP pack min Do not send Blood Bank specimens to the main laboratory; send them directly to Blood Bank (tube #400). Sending Blood Bank specimens to the main laboratory results in delays of 30 minutes. Blood Bank tests include: o Type & Screen pink top o ABO verification tan top o TEG 6S blue top Blood Bank automatically prepares a keep-ahead MTP pack ahead of request to minimize delays. Patients younger than 15 years old require group AB plasma. Processing time for group AB plasma may be minutes during critical inventory shortages. Contact: Ariana King Revised January 2018

3 EMERGENCY RANSFUSION RELEASE PROTOCOL BLOOD REQUEST 1. GIVE O NEG RBCS FROM REFRIGERATOR IF AVAILABLE 2. CALL BLOOD BANK: a. I need (quantity) units of emergency release. b. The patient s name is and MRN is. c. Patient is years old and their date of birth is. d. The patient is a (male or female). e. Patient s location is (unit), room. f. The physician requesting blood is. (give full name) g. My name is and my call-back number is. 3. YOU MAY REQUEST BLOOD PRODUCT QUANTITIY RED BLOOD CELLS 1-5 UNITS FRESH FROZEN PLASMA 1-3 UNITS PLATELETPHERESIS 1 UNIT a. Allow up to 5 minutes to receive products b. Plasma may require up to 30 minutes if thawing is required 4. PLACE EPIC TRANSFUSION ORDER(S) WHEN TIME PERMITS a. Keyword search emergency, transfuse, or release 5. CALL BLOOD BANK FOR PRODUCTS OR MTP **ACTIVATE MTP IF 6 RBCS NEEDED FOR ADULTS** Author: Ariana King. January UChicago Medicine.

4 EMERGENCY RANSFUSION RELEASE PROTOCOL BLOOD REQUEST BLOOD BANK IS IN CCD EAST, 2ND FLOOR ROOM: PHONE: TUBE: 400 Author: Ariana King. January UChicago Medicine.

5 MASSIVE TRANSFUSION PROTOCOL Adult or Obstetrics Activation 1. CALL BLOOD BANK TO ACTIVATE: a. I am activating the Massive Transfusion Protocol. b. My name is and my call-back number is. c. The patient s name is and MRN is. d. Patient is years old and their date of birth is. e. Patient is a. (male or female) f. Patient s location is (unit), room. g. We need a (single or continuous) pack. h. The physician requesting MTP is. (give full name) 2. CARE TEAM RUNNER WILL TRANSPORT: RBCS FFP PLT 1 CRYO POOL 2 ADULT upon request OBSTETRICS One (1) plateletpheresis = Six (6) or more platelet units; each plateletpheresis is one (1) dose. 2. One (1) cryoprecipitate pool = Five (5) cryoprecipitate units. a. Cryoprecipitate pool only available by request for non-ob patients b. Allow up to 10 minutes to receive first MTP pack c. Allow up to 30 minutes to receive cryoprecipitate or plasma requiring thaw 3. CALL BLOOD BANK IF: a. Additional MTP pack needed (single-pack MTP only) b. Different MTP needed (e.g. from continuous to a single-pack) c. Patient transferred to new unit 4. PLACE EPIC ORDER(S) WHEN TIME PERMITS 5. CALL BLOOD BANK TO DEACTIVATE Author: Ariana King. January UChicago Medicine.

6 MASSIVE TRANSFUSION PROTOCOL Adult or Obstetrics Activation BLOOD BANK IS IN CCD EAST, 2 ND FLOOR ROOM: PHONE: TUBE: Activate 2. Resuscitate 3. Communicate 4. Deactivate Author: Ariana King. January UChicago Medicine.

7 MASSIVE TRANSFUSION PROTOCOL Pediatric Activation 1. CALL BLOOD BANK TO ACTIVATE: a. I am activating the Massive Transfusion Protocol. b. The patient s name is and MRN is. c. Patient is years/months old and their date of birth is. d. The patient weighs kg. e. Patient is a. (male or female) f. Patient s location is (unit), room. g. We need a (single or continuous) pack. h. The physician requesting the MTP is. (give full name) i. My name is and my call-back number is. 2. CARE TEAM RUNNER WILL TRANSPORT: Products Sent with MTP Runner Recommended Administration <40 kg 40 kg 5-9 kg kg kg kg 40 kg 3 RBC 6 RBC 1 RBC 2 RBC 3 RBC 4 RBC 6 RBC 2 FFP 4 FFP 1 FFP 2 FFP 3 FFP 4 FFP 4 FFP 1 PLT 1 1 PLT 1 ½ PLT ½ PLT ½ PLT 1 PLT 1 PLT Cryo by request only 1 UNIT Cryo 1 UNIT Cryo 1 UNIT Cryo 1 POOL Cryo 2 1 POOL Cryo 2 1. ONE (1) PLATELETPHERESIS = SIX (6) OR MORE PLATELET UNITS. 2. ONE (1) CRYOPRECIPITATE POOL = FIVE (5) CRYOPRECIPITATE UNITS. a. May request cryoprecipitate if needed b. Allow up to 10 minutes to receive first MTP pack c. Allow up to 30 minutes to receive cryoprecipitate 3. CALL BLOOD BANK IF: a. Additional MTP pack needed b. Different MTP needed (e.g. from continuous to a single-pack) c. Patient transferred to new unit 4. PLACE EPIC ORDER(S) WHEN TIME PERMITS 5. CALL BLOOD BANK TO DEACTIVATE Author: Ariana King. January 2018, UChicago Medicine.

8 MASSIVE TRANSFUSION PROTOCOL Pediatric Activation BLOOD BANK IS IN CCD EAST, 2ND FLOOR ROOM: PHONE: TUBE: Activate 2. Resuscitate 3. Communicate 4. Deactivate Author: Ariana King. January 2018, UChicago Medicine.

9 Massive Transfusion Protocol (MTP) Algorithm Adult, Obstetrics, Pediatrics MTP Roles (Key) Attending or Designee Bedside Clinician (MD or RN) Care Team Contact Care Team Runner Recognize blood loss & mobilize care team Activate MTP Call Blood Bank Send T&S and/or ABO2ND if needed Blood Bank tube 400 MTP coolers packed and issued to runner(s) until deactivation CONTINUOUS Single or Continuous pack? SINGLE 1 MTP cooler issued, next cooler packed upon request Send Hemorrhage Panel after each MTP pack Main lab tube 901 Send Hemorrhage Panel after each MTP pack Main lab tube 901 Patient is stable NO Need more products? YES Call to request MTP pack, send a runner Blood Bank Enter MTP transfusion order(s) in Epic, return coolers ASAP MTP Pack Contents: Deactivate MTP Call Blood Bank RBCS FFP PLT CRYO POOL Adult on request Obstetrics Important Blood Bank Info: Phone: Tube #: 400 Room: CCD 2730 Turn-Around-Times 1 st MTP pack 10 min Thaw time (Frozen plasma or cryo) min Stat Type & Screen (T&S) 60 min from receipt Stat ABO verification (ABO2ND) 15 min from receipt Products Sent with MTP Runner Recommended Administration <40 kg 40 kg 5-9 kg kg kg kg 40 kg 3 RBC 6 RBC 1 RBC 2 RBC 3 RBC 4 RBC 6 RBC 2 FFP 4 FFP 1 FFP 2 FFP 3 FFP 4 FFP 4 FFP 1 PLT 1 1 PLT 1 ½ PLT ½ PLT ½ PLT 1 PLT 1 PLT Cryo by request only 1 POOL 1 POOL 1 UNIT Cryo 1 UNIT Cryo 1 UNIT Cryo Cryo 2 Cryo 2 Author: Ariana King Revised January 2018

10 Massive Transfusion Protocol Tip Sheet Care Team Runners 1. Take a patient demographic sticker or other form of patient ID (anything with name & MRN) Patient name and MRN is required to pick up MTP cooler 2. Take the MTP Card from your unit for emergency elevator access Double tap MTP card to recall the elevator Return the card to your unit after each use Card use is monitored by Public Safety and Blood Bank Quality Assurance 3. Go to the Blood Bank, CCD East room and ring the doorbell (red circle) Follow way-finding signs to Blood Bank or use map from Emergency Transfusion Guide on crash cart 4. Transport the cooler directly to the care team 5. Keep the MTP cooler at the patient s bedside until the MTP is deactivated Cooler expiration time and patient ID will be on the front of the cooler (blue circle) Cooler expires four hours from when it is packed Keep cooler closed except to retrieve & give products DO NOT place platelets or cryoprecipitate inside cooler Store platelets and cryoprecipitate in the pack attached to cooler (red arrow) 6. Care team must return the cooler(s) to the Blood Bank if MTP is deactivated Cooler is within 15 minutes of expiration Cooler is empty and will be swapped for a new MTP pack Author: Ariana King January 2018